Aims

This analysis aims to investigate the risk of death or subsequent readmission in patients who have had an emergency hospital admission. It will help us understand what factors influence the risk of death or readmission, including determining variability between ICB area. This could help identify where activity might be mitigated through appropriate community services provision.

Methodology

Three patient cohorts are included within this analysis:

Elderly emergency: those 75 or over with an emergency admission.
Frail: those 65 or over with an emergency admission and a frailty score over 5. The frailty score is calculated from ICD-10 diagnoses recorded for admissions during the previous 2 years and using the risk scores in Gilbert et al (2018), Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. The Lancet, 391(10132), pp.1775-1782. (Note these patients are a subset for those in the elderly emergency cohort)
Falls: those 65 or over with an emergency admission related to a fall.

The End of life cohort are not included as by definition they die during their hospital admission.

Survival analysis has been conducted using data from 2023/23 for

Time to death (mortality)
Time to readmission (time to readmission from the first admission for all patients including some that will have died in the year post-admission)
Time to readmission- excluding those who died prior to readmission

Note: Frimley ICB has been removed from the analysis due to missing data.

Mortality

The time from when a patient first had an emergency admission and first entered the cohort until death was calculated. Those who died on the same day as their emergency admission when they first entered the cohort were excluded.

Trends in the percentage of deaths over time

The proportion of patients who die is higher within the elderly emergency and frail cohorts compared to the falls cohort.

Generally the proportion of deaths within either 28 days or 1 year have remained stable over time. A slightly lower percentage of deaths within 1 year is to be expected for those first admitted in 2023/24 as there is not a full year of follow-up and some deaths will have not yet occurred.

Summary of percentage of patients dying within 1 year (2022/23)

	Elderly Emergency	Frail	Falls
Sex
female	153,304 (27.6%)	116,885 (27.2%)	19,988 (21.5%)
male	144,597 (32.6%)	116,496 (31.2%)	14,267 (30.9%)
Age
60-64	N/A	N/A	144 (8.5%)
65-69	N/A	16,436 (16.8%)	1,003 (10.2%)
70-74	N/A	27,103 (20%)	2,302 (13.8%)
75-79	66,638 (21.1%)	37,385 (23.9%)	4,156 (17.7%)
80-84	77,711 (26.7%)	48,410 (29.6%)	6,941 (23.3%)
85-89	81,698 (34.5%)	53,965 (36.9%)	9,322 (29.1%)
90+	71,854 (46.6%)	50,082 (48.5%)	10,387 (40.4%)
Ethnicity
Asian/Asian British	6,250 (24.4%)	5,251 (22.6%)	485 (19.4%)
Black/Black British	3,127 (25.6%)	2,480 (25%)	229 (19.6%)
Mixed	637 (25.7%)	562 (25.6%)	65 (21.9%)
Other	2,997 (27.1%)	2,440 (25.1%)	315 (19.9%)
White British	246,628 (30.2%)	192,855 (29.6%)	28,761 (25.2%)
White Other	9,929 (28.9%)	7,831 (28.1%)	1,169 (23.1%)
Unknown	28,333 (29.3%)	21,962 (27.5%)	3,231 (22.4%)
IMD decile
1	24,999 (32.1%)	22,026 (30.2%)	2,925 (25.5%)
2	26,503 (31.7%)	22,394 (30.3%)	3,248 (25.7%)
3	26,973 (30.9%)	22,154 (29.6%)	3,250 (25.4%)
4	29,863 (31%)	23,434 (29.8%)	3,346 (24.9%)
5	31,003 (30.1%)	24,284 (29.4%)	3,509 (24.5%)
6	32,350 (29.6%)	24,619 (28.8%)	3,720 (24.6%)
7	32,695 (29.4%)	24,828 (28.8%)	3,681 (24.5%)
8	32,454 (28.9%)	24,659 (28.6%)	3,625 (24%)
9	31,686 (28.4%)	23,624 (27.9%)	3,677 (24.3%)
10	29,375 (27.8%)	21,359 (27.3%)	3,274 (23.2%)

Total	297,901 (29.8%)	233,381 (29%)	34,255 (24.6%)

Comparing time to death between the cohorts using Kaplan-meier plot (2022/23)

For those first admitted in 2022/23 we considered the time to death from when the person was first admitted. The most recent year 2023/2024 was not used as there has not be sufficient time for those that entered the cohort at the end of this year to have a full year of follow-up time.

The risk of death is highest in the frail cohort, followed by the elderly emergency cohort, with those in the falls cohort have a lowest risk of death.

Kaplan Meier survival plots of time to death (2022/23)

Summary

The risk of death is increased:

with age
in males
with increasing deprivation
in those who are White British, compared to all other those of other ethnicities

There is some variation between ICBs in the risk of death with the lowest risk seen in the North West London ICB area.

ICB	Deaths	No. at risk	Percentage
QRV: NHS North West London ICB	6,849	27,484	24.9
QUY: NHS Bristol, N S'set & S Gloucs ICB	4,666	16,818	27.7
QRL: NHS Hampshire And Isle Of Wight ICB	10,666	38,428	27.8
QHL: NHS Birmingham And Solihull ICB	6,382	22,495	28.4
QMJ: NHS North Central London ICB	4,193	14,789	28.4
QOX: NHS Bath & NE S'set, S'don & W ICB	4,858	17,130	28.4
QK1: NHS Leics, Leic'shire & Rutland ICB	5,067	17,771	28.5
QNC: NHS Staffordshire & Stoke-On-Tr ICB	6,912	24,269	28.5
QU9: NHS Bucks, Oxford & Berkshire W ICB	7,984	28,049	28.5
QXU: NHS Surrey Heartlands ICB	5,986	20,998	28.5
QVV: NHS Dorset ICB	5,714	19,896	28.7
QOC: NHS Shrops, Telford & Wrekin ICB	2,968	10,293	28.8
QJK: NHS Devon ICB	7,844	26,939	29.1
QKS: NHS Kent And Medway ICB	10,060	34,471	29.2
QKK: NHS South East London ICB	6,225	21,259	29.3
QMF: NHS North East London ICB	5,466	18,643	29.3
QWE: NHS South West London ICB	5,427	18,500	29.3
QR1: NHS Gloucestershire ICB	3,313	11,237	29.5
QT6: NHS Cornwall & Isles Of Scilly ICB	2,928	9,939	29.5
QSL: NHS Somerset ICB	4,061	13,732	29.6
QNX: NHS Sussex ICB	10,862	36,457	29.8
QWU: NHS Coventry And Warwickshire ICB	5,415	18,159	29.8
QHM: NHS North East & North Cumbria ICB	19,714	65,902	29.9
QUA: NHS Black Country ICB	7,396	24,576	30.1
QHG: NHS Beds, Luton & Milton Keynes ICB	4,501	14,927	30.2
QYG: NHS Cheshire And Merseyside ICB	15,278	50,607	30.2
QM7: NHS Hertfordshire & West Essex ICB	8,061	26,636	30.3
QJ2: NHS Derby And Derbyshire ICB	6,637	21,849	30.4
QF7: NHS South Yorkshire ICB	8,407	27,379	30.7
QPM: NHS Northamptonshire ICB	4,008	13,051	30.7
QE1: NHS Lancashire & South Cumbria ICB	10,652	34,591	30.8
QH8: NHS Mid And South Essex ICB	7,208	23,207	31.1
QJM: NHS Lincolnshire ICB	4,941	15,888	31.1
QJG: NHS Suffolk & North East Essex ICB	6,632	21,272	31.2
QOQ: NHS Humber And North Yorkshire ICB	11,283	36,146	31.2
QUE: NHS Cambs & Peterborough ICB	4,836	15,406	31.4
QGH: NHS Herefords & Worcestershire ICB	4,710	14,967	31.5
QOP: NHS Greater Manchester ICB	14,402	45,513	31.6
QT1: NHS Nott'ham & Nottinghamshire ICB	6,366	20,151	31.6
QWO: NHS West Yorkshire ICB	12,349	38,283	32.3
QMM: NHS Norfolk And Waveney ICB	7,314	22,419	32.6

Summary

The risk of death is increased:

with age
in males
with increasing deprivation
in those who are White British, compared to all other those of other ethnicities

There is some variation between ICBs in the risk of death, with many of the London ICB areas having a lower risk of death.

ICB	Deaths	No. at risk	Percentage
QT6: NHS Cornwall & Isles Of Scilly ICB	229	1,200	19.1
QMJ: NHS North Central London ICB	503	2,542	19.8
QRV: NHS North West London ICB	847	4,079	20.8
QOX: NHS Bath & NE S'set, S'don & W ICB	543	2,486	21.8
QOC: NHS Shrops, Telford & Wrekin ICB	283	1,290	21.9
QU9: NHS Bucks, Oxford & Berkshire W ICB	844	3,757	22.5
QKS: NHS Kent And Medway ICB	755	3,310	22.8
QWE: NHS South West London ICB	660	2,891	22.8
QNX: NHS Sussex ICB	1,254	5,485	22.9
QRL: NHS Hampshire And Isle Of Wight ICB	1,391	6,055	23.0
QNC: NHS Staffordshire & Stoke-On-Tr ICB	645	2,751	23.4
QXU: NHS Surrey Heartlands ICB	676	2,867	23.6
QKK: NHS South East London ICB	987	4,166	23.7
QJK: NHS Devon ICB	767	3,206	23.9
QVV: NHS Dorset ICB	636	2,663	23.9
QYG: NHS Cheshire And Merseyside ICB	1,607	6,722	23.9
QJ2: NHS Derby And Derbyshire ICB	594	2,466	24.1
QMF: NHS North East London ICB	820	3,391	24.2
QJM: NHS Lincolnshire ICB	508	2,085	24.4
QT1: NHS Nott'ham & Nottinghamshire ICB	646	2,648	24.4
QGH: NHS Herefords & Worcestershire ICB	531	2,159	24.6
QHM: NHS North East & North Cumbria ICB	2,203	8,901	24.8
QUE: NHS Cambs & Peterborough ICB	560	2,257	24.8
QSL: NHS Somerset ICB	467	1,859	25.1
QE1: NHS Lancashire & South Cumbria ICB	1,241	4,927	25.2
QJG: NHS Suffolk & North East Essex ICB	747	2,949	25.3
QM7: NHS Hertfordshire & West Essex ICB	983	3,867	25.4
QPM: NHS Northamptonshire ICB	468	1,844	25.4
QHL: NHS Birmingham And Solihull ICB	715	2,804	25.5
QWU: NHS Coventry And Warwickshire ICB	654	2,539	25.8
QK1: NHS Leics, Leic'shire & Rutland ICB	600	2,319	25.9
QOP: NHS Greater Manchester ICB	1,653	6,377	25.9
QHG: NHS Beds, Luton & Milton Keynes ICB	639	2,426	26.3
QOQ: NHS Humber And North Yorkshire ICB	1,165	4,417	26.4
QWO: NHS West Yorkshire ICB	1,470	5,489	26.8
QMM: NHS Norfolk And Waveney ICB	910	3,378	26.9
QR1: NHS Gloucestershire ICB	414	1,523	27.2
QF7: NHS South Yorkshire ICB	1,017	3,728	27.3
QUY: NHS Bristol, N S'set & S Gloucs ICB	702	2,570	27.3
QUA: NHS Black Country ICB	966	3,524	27.4
QH8: NHS Mid And South Essex ICB	1,046	3,650	28.7

Summary

The risk of death is increased:

with age
in males
with increasing deprivation
in those who are White British, compared to all other those of other ethnicities

There is some variation between ICBs in the risk of death, with the lowest risk of death seen in the North West London ICB area.

ICB	Deaths	No. at risk	Percentage
QRV: NHS North West London ICB	5,644	23,660	23.9
QOX: NHS Bath & NE S'set, S'don & W ICB	3,426	12,814	26.7
QNC: NHS Staffordshire & Stoke-On-Tr ICB	5,453	20,248	26.9
QXU: NHS Surrey Heartlands ICB	4,412	16,387	26.9
QVV: NHS Dorset ICB	4,046	14,882	27.2
QHL: NHS Birmingham And Solihull ICB	5,016	18,286	27.4
QRL: NHS Hampshire And Isle Of Wight ICB	8,039	29,320	27.4
QUY: NHS Bristol, N S'set & S Gloucs ICB	3,621	13,194	27.4
QU9: NHS Bucks, Oxford & Berkshire W ICB	6,174	22,196	27.8
QMJ: NHS North Central London ICB	3,294	11,777	28.0
QK1: NHS Leics, Leic'shire & Rutland ICB	3,972	14,073	28.2
QWE: NHS South West London ICB	4,340	15,363	28.2
QOC: NHS Shrops, Telford & Wrekin ICB	2,296	8,102	28.3
QSL: NHS Somerset ICB	3,018	10,657	28.3
QT6: NHS Cornwall & Isles Of Scilly ICB	2,077	7,338	28.3
QKK: NHS South East London ICB	5,247	18,472	28.4
QHM: NHS North East & North Cumbria ICB	15,912	55,575	28.6
QR1: NHS Gloucestershire ICB	2,404	8,346	28.8
QNX: NHS Sussex ICB	8,245	28,548	28.9
QJK: NHS Devon ICB	5,759	19,884	29.0
QKS: NHS Kent And Medway ICB	7,063	24,247	29.1
QMF: NHS North East London ICB	4,559	15,668	29.1
QYG: NHS Cheshire And Merseyside ICB	12,608	43,345	29.1
QUA: NHS Black Country ICB	5,976	20,483	29.2
QHG: NHS Beds, Luton & Milton Keynes ICB	3,572	12,162	29.4
QWU: NHS Coventry And Warwickshire ICB	4,379	14,819	29.5
QF7: NHS South Yorkshire ICB	6,626	22,358	29.6
QJM: NHS Lincolnshire ICB	3,832	12,955	29.6
QM7: NHS Hertfordshire & West Essex ICB	6,185	20,929	29.6
QJ2: NHS Derby And Derbyshire ICB	5,188	17,415	29.8
QH8: NHS Mid And South Essex ICB	5,752	19,048	30.2
QE1: NHS Lancashire & South Cumbria ICB	8,626	28,270	30.5
QPM: NHS Northamptonshire ICB	3,372	11,062	30.5
QOP: NHS Greater Manchester ICB	11,827	38,669	30.6
QOQ: NHS Humber And North Yorkshire ICB	8,835	28,868	30.6
QT1: NHS Nott'ham & Nottinghamshire ICB	5,079	16,469	30.8
QWO: NHS West Yorkshire ICB	9,986	32,383	30.8
QUE: NHS Cambs & Peterborough ICB	3,866	12,459	31.0
QGH: NHS Herefords & Worcestershire ICB	3,608	11,594	31.1
QJG: NHS Suffolk & North East Essex ICB	5,113	16,212	31.5
QMM: NHS Norfolk And Waveney ICB	5,479	17,331	31.6

Multivariate survival analysis of time to death (2022/23)

For this analysis we have taken only data from 2022-2023, and only the first admission for each patient. We have excluded admissions where the person died on the day of admission.

We have fitted multivariate Cox proportional hazard models to our data to assess how various factors independently affect the risk of readmission occurring over time.

Assumptions of Cox proportional hazards models

Cox proportional hazards models assume that the hazard rate (in this case risk of death) for a person with one set of covariates is proportional to the hazard rate for a person with a different set of covariates, so that the hazard ratio is assumed to be constant over time.

The proportional hazards (PH) assumption can be checked using statistical tests and graphical diagnostics based on the scaled Schoenfeld residuals.

We find significant p-values for some covariates, particularly for ICBs, indicating that the data violates the proportional hazards assumption. This is unsurprising as we have very high number of patients included within our dataset, which means even very small deviations in the residuals over time can result in significant p-values.

Plotting a smoothed fit to the Schoenfeld residuals allows us to determine, where p-values are significant, whether the changes in the beta coefficient over time are large enough to meaningfully impact our analyses. Deviations from a horizontal line indicate non-proportional hazards, and that the hazard ratio will be changing over time.

There are alternatives when the proportional hazards assumption is violated such as adding a time interaction into the model or using an alternative accelerated failure model. With the size of our dataset and the number of covariates (over 40 ICBs) the alternatives do not appear feasible and would unlikely add useful information to our conclusions.

Considering these factors and that for this analysis the degree of variation and trends are more important than the absolute hazard ratios we have used a Cox proportional hazards models, and the calculated hazard ratios can be considered as a time-averaged hazard ratio. We have modelled the risk of death within 28 days and within 1 yr. Considering the first 28 day period alongside the 1 year time period means we can check for any initial differences in the first 28 days that might be averaged out in the long 1 year period. There are some differences in the hazard ratios calculated for the two models, but the general trends are consistent.

Elderly emergency

Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.

              chisq df      p sig
sex         43.1050  1 0.0000   *
age_range  141.4244  1 0.0000   *
ethnicity    0.2548  1 0.6137    
imd_decile   0.1283  1 0.7202    
icb          1.0181  1 0.3130    
GLOBAL     250.2182 59 0.0000   *

              chisq df      p sig
sex         36.3556  1 0.0000   *
age_range  331.1640  1 0.0000   *
ethnicity    0.0095  1 0.9225    
imd_decile   1.2292  1 0.2676    
icb          1.0411  1 0.3076    
GLOBAL     647.4959 59 0.0000   *

Summary

In the elderly emergency cohort the risk of death post-admission:

is higher in males.
increases with increasing age.
up to 28 days those who are Black/Black British or White Other ethnicity have a lower risk of death compared to White British, while Other and Unknown ethnicities have an increased risk. In the 1 year post-admission the risk of death is lower compared to White British for all other ethnicities, apart from Unknown.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) have a higher risk of death than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of death is lowest in the North West London ICB area and highest in the Norfolk and Waveney ICB area.

Falls

               chisq df      p sig
sex           0.0197  1 0.8885    
age_range  2339.4301  1 0.0000   *
ethnicity     0.3180  1 0.5728    
imd_decile    0.0431  1 0.8355    
icb          97.5354  1 0.0000   *
GLOBAL       90.6398 62 0.0103   *

               chisq df      p sig
sex           0.2474  1 0.6189    
age_range  9669.4290  1 0.0000   *
ethnicity     0.0003  1 0.9868    
imd_decile    0.0001  1 0.9940    
icb           1.3258  1 0.2496    
GLOBAL      215.6440 62 0.0000   *

Summary

In the falls cohort the risk of death post-admission:

is higher in males.
increases with increasing age.
up to 28 days those who are Asian/Asian British, Black/Black British, Other or Unknown ethnicity have a lower risk of death compared to White British. In the year post-admission the risk of death is lower for those who are Black/Black British or White Other ethnicities compared to White British.
up to 28days is not as clearly correlated with deprivation. However, in the year post-admission risk of death increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) have a higher risk of death than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of death in the year post-admission is lowest in the North West London ICB and North Central London ICB areas, and highest in the Gloucestershire ICB and Mind and South Essex ICB areas. In the 28 days post-admission the risk of readmission is lowest in the South East London ICB area, and highest in the Gloucestershire ICB area.

Frail

               chisq df      p sig
sex          20.3869  1 0.0000   *
age_range  5270.0670  1 0.0000   *
ethnicity     0.0607  1 0.8054    
imd_decile    0.7662  1 0.3814    
icb           1.1947  1 0.2744    
GLOBAL      341.6358 61 0.0000   *

               chisq df      p sig
sex          24.9518  1 0.0000   *
age_range  3124.1412  1 0.0000   *
ethnicity     0.1863  1 0.6660    
imd_decile    0.0331  1 0.8557    
icb           1.4747  1 0.2246    
GLOBAL      531.9057 61 0.0000   *

Summary

In the frail cohort the risk of death post-admission:

is higher in males.
increases with increasing age.
up to 28 days those who are of Unknown ethnicity have a higher risk of death compared to White British. While in the 1 year post-admission the risk of death is lower for those of Asian/Asian British, Black/Black British and Other ethnicities compared to White British.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) have a higher risk of death than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of death in the year post-admission is lowest in the North West London ICB and Dorset ICB areas and highest in the Humber and North Yorkshire ICB and Hereford and Worcestershire ICB areas. In the 28 days post-admission the risk of readmission is lowest in the North West London ICB and Bristol, North Somerset and South Gloucestershire ICB areas, and highest in the Hereford and Worcestershire ICB and Cornwall and Isles of Scilly ICB areas.

Number of deaths on day of admission by ethnicity

For the survival analysis we excluded anyone who died on the day of first admission, so given the differences seen in the risk of death by ethnicity we have checked whether there are differences in the percentage of patients who die on the day of first admission by ethnicity.

Ethnicity	Percentage who die on day of admissions
White British	0.34
Asian/Asian British	0.34
Black/Black British	0.33
Mixed	0.32
Other	0.25
White Other	0.27
Unknown	0.45

The percentage of patient who die on the day of admission is slightly higher for those who are Asian/Asian British and of Unknown ethnicity compared to those who are White British.

Readmissions

Trends in the percentage of admissions with a subsequent readmission over time

Generally the proportion of admissions that have resulted in a readmission within either 28 days or 1 year have remained stable over time.

The proportion of patient with a readmission is higher in the elderly emergency and frail cohorts compared to the falls cohort.

A lower percentage of readmissions within 1 year is to be expected for those admitted in 2023/24 as there is not a full year of follow-up and some readmissions will have not yet occurred.

Summary of percentage of patients readmitted within 1 year (2022/23)

All admissions are counted an individual events, so some patients with multiple admissions will be included more than once.

	Elderly Emergency	Frail	Falls
Sex
female	264,354 (31.2%)	164,982 (29.6%)	21,787 (21.6%)
male	263,236 (37.3%)	171,377 (34.3%)	15,616 (31.2%)
Age
60-64	N/A	N/A	151 (8.4%)
65-69	N/A	24,250 (19.6%)	1,095 (10.4%)
70-74	N/A	40,001 (22.9%)	2,497 (14%)
75-79	122,997 (25.8%)	55,149 (26.9%)	4,537 (17.9%)
80-84	141,841 (31%)	70,137 (32.3%)	7,609 (23.6%)
85-89	144,122 (38.3%)	77,429 (39.3%)	10,227 (29.3%)
90+	118,630 (49%)	69,393 (50%)	11,287 (40.1%)
Ethnicity
Asian/Asian British	11,856 (28.8%)	7,875 (25.6%)	527 (19.6%)
Black/Black British	6,008 (30%)	3,807 (28%)	252 (19.4%)
Mixed	1,185 (30.5%)	843 (29.2%)	74 (22.6%)
Other	5,333 (31.2%)	3,450 (27.3%)	354 (20.3%)
White British	438,842 (34.4%)	278,647 (32.4%)	31,406 (25.4%)
White Other	18,256 (33.2%)	11,552 (31%)	1,279 (23%)
Unknown	46,110 (33.2%)	30,185 (30.3%)	3,511 (22.9%)
IMD decile
1	46,361 (36.5%)	32,300 (32.9%)	3,142 (25.4%)
2	48,872 (35.9%)	33,314 (33.3%)	3,590 (25.9%)
3	49,205 (35.1%)	32,414 (32.4%)	3,576 (25.6%)
4	52,884 (35%)	33,871 (32.6%)	3,661 (25.1%)
5	54,735 (34.2%)	34,818 (32.2%)	3,820 (24.7%)
6	56,492 (33.6%)	35,336 (31.6%)	4,040 (24.7%)
7	56,913 (33.4%)	35,272 (31.6%)	4,001 (24.7%)
8	56,678 (33.1%)	35,110 (31.4%)	3,975 (24.4%)
9	54,924 (32.4%)	33,617 (30.7%)	4,027 (24.7%)
10	50,526 (31.7%)	30,307 (30.1%)	3,571 (23.4%)

Total	527,590 (34%)	336,359 (31.8%)	37,403 (24.8%)

Number of readmissions in 2022/2023

cohort	mean	upper quartile	max
elderly emergency	0.55	1	67
falls	0.08	0	7
frail	0.31	0	36

The majority of patients have no readmission within a year, and of those that do have a readmission it is most common to just have a single readmission. A small number of patients are having more regular emergency admissions; those with a highest rates appear to be often admitted and discharged on the same day.

Comparing time to readmission between the cohorts using Kaplan-meier plots (2022/23)

Survival analysis was conducted where each admission is treated as an independent event. This means some patients who had multiple admissions within 2022/23 will be included multiple times.

Survival analysis was conducted using a patient’s first admission within 2022/23, so only one event is included per patient, even if the patient has multiple admissions over the year.

The risk of readmission is very similar between the elderly emergency and frail cohorts (note the frail cohort is a subset of the elderly emergency cohort). Those in the falls cohort have a lower risk of readmission.

The risk of admissions is increased slightly by a small subset of patients that have multiple readmissions, as the risk of readmission decreases if only the first admission/ readmission is included for each patient.

Kaplan Meier survival plots of time to readmission (2022/23)

For these plots each admission in 2022/23 was treated as an independent event, meaning that some patients who had multiple admissions within 2022/23 will be included multiple times.

Summary

The risk of readmission is higher in those who are:

aged 80-89, compared to those aged 75-79 or 90+.
male
Asian/Asian British or Black/Black British compared to White British
living in a more deprived area

The risk of readmission varies by ICB area, with a lower risk of readmission in the Dorset, Gloucestershire and Cornwall and Isles of Scilly ICB areas and a higher risk in the North West London ICB area.

ICB	Readmissions	No. at risk	Percentage
QR1: NHS Gloucestershire ICB	6,998	15,845	44.2
QT6: NHS Cornwall & Isles Of Scilly ICB	6,206	13,711	45.3
QVV: NHS Dorset ICB	13,829	30,091	46.0
QOC: NHS Shrops, Telford & Wrekin ICB	7,257	15,202	47.7
QGH: NHS Herefords & Worcestershire ICB	10,612	22,144	47.9
QJM: NHS Lincolnshire ICB	11,264	23,504	47.9
QMM: NHS Norfolk And Waveney ICB	15,668	32,669	48.0
QOX: NHS Bath & NE S'set, S'don & W ICB	12,220	25,295	48.3
QJG: NHS Suffolk & North East Essex ICB	15,789	32,004	49.3
QJK: NHS Devon ICB	19,921	40,128	49.6
QNX: NHS Sussex ICB	27,098	54,627	49.6
QE1: NHS Lancashire & South Cumbria ICB	26,021	51,998	50.0
QKS: NHS Kent And Medway ICB	26,752	53,431	50.1
QSL: NHS Somerset ICB	10,398	20,710	50.2
QK1: NHS Leics, Leic'shire & Rutland ICB	13,649	26,907	50.7
QOQ: NHS Humber And North Yorkshire ICB	28,360	55,352	51.2
QWO: NHS West Yorkshire ICB	30,525	59,219	51.5
QT1: NHS Nott'ham & Nottinghamshire ICB	15,900	30,841	51.6
QU9: NHS Bucks, Oxford & Berkshire W ICB	22,738	43,801	51.9
QUY: NHS Bristol, N S'set & S Gloucs ICB	13,351	25,704	51.9
QH8: NHS Mid And South Essex ICB	18,869	36,236	52.1
QM7: NHS Hertfordshire & West Essex ICB	21,674	41,599	52.1
QYG: NHS Cheshire And Merseyside ICB	40,890	78,122	52.3
QMJ: NHS North Central London ICB	12,058	22,830	52.8
QOP: NHS Greater Manchester ICB	37,648	71,233	52.9
QRL: NHS Hampshire And Isle Of Wight ICB	31,835	60,115	53.0
QWE: NHS South West London ICB	15,475	29,159	53.1
QXU: NHS Surrey Heartlands ICB	17,860	33,584	53.2
QHG: NHS Beds, Luton & Milton Keynes ICB	12,699	23,819	53.3
QWU: NHS Coventry And Warwickshire ICB	15,423	28,913	53.3
QUE: NHS Cambs & Peterborough ICB	13,289	24,661	53.9
QJ2: NHS Derby And Derbyshire ICB	19,211	35,321	54.4
QUA: NHS Black Country ICB	21,281	39,069	54.5
QHM: NHS North East & North Cumbria ICB	58,067	106,347	54.6
QHL: NHS Birmingham And Solihull ICB	19,694	35,806	55.0
QNC: NHS Staffordshire & Stoke-On-Tr ICB	21,162	38,497	55.0
QMF: NHS North East London ICB	17,385	30,977	56.1
QF7: NHS South Yorkshire ICB	25,052	44,538	56.2
QPM: NHS Northamptonshire ICB	12,261	21,783	56.3
QKK: NHS South East London ICB	19,908	35,304	56.4
QRV: NHS North West London ICB	27,209	46,491	58.5

Summary

The risk of readmission is higher in those who are:

aged over 75 years.
male
Black/Black British

In this falls cohort there is no clear association between deprivation and risk of readmission.

The risk of readmission varies by ICB area.

ICB	Readmissions	No. at risk	Percentage
QT6: NHS Cornwall & Isles Of Scilly ICB	443	1,253	35.4
QR1: NHS Gloucestershire ICB	571	1,606	35.6
QOC: NHS Shrops, Telford & Wrekin ICB	515	1,340	38.4
QGH: NHS Herefords & Worcestershire ICB	925	2,310	40.0
QJK: NHS Devon ICB	1,380	3,351	41.2
QJM: NHS Lincolnshire ICB	913	2,212	41.3
QK1: NHS Leics, Leic'shire & Rutland ICB	1,025	2,437	42.1
QMM: NHS Norfolk And Waveney ICB	1,543	3,597	42.9
QSL: NHS Somerset ICB	856	1,996	42.9
QOX: NHS Bath & NE S'set, S'don & W ICB	1,168	2,675	43.7
QOQ: NHS Humber And North Yorkshire ICB	2,059	4,685	43.9
QE1: NHS Lancashire & South Cumbria ICB	2,314	5,261	44.0
QVV: NHS Dorset ICB	1,283	2,879	44.6
QJG: NHS Suffolk & North East Essex ICB	1,422	3,170	44.9
QJ2: NHS Derby And Derbyshire ICB	1,169	2,591	45.1
QNX: NHS Sussex ICB	2,675	5,929	45.1
QT1: NHS Nott'ham & Nottinghamshire ICB	1,293	2,831	45.7
QU9: NHS Bucks, Oxford & Berkshire W ICB	1,859	4,043	46.0
QWO: NHS West Yorkshire ICB	2,757	5,866	47.0
QUY: NHS Bristol, N S'set & S Gloucs ICB	1,331	2,796	47.6
QYG: NHS Cheshire And Merseyside ICB	3,413	7,139	47.8
QMJ: NHS North Central London ICB	1,359	2,786	48.8
QOP: NHS Greater Manchester ICB	3,348	6,819	49.1
QKS: NHS Kent And Medway ICB	1,794	3,649	49.2
QM7: NHS Hertfordshire & West Essex ICB	2,077	4,211	49.3
QHM: NHS North East & North Cumbria ICB	4,773	9,638	49.5
QXU: NHS Surrey Heartlands ICB	1,553	3,131	49.6
QUE: NHS Cambs & Peterborough ICB	1,242	2,462	50.4
QHG: NHS Beds, Luton & Milton Keynes ICB	1,360	2,680	50.7
QWU: NHS Coventry And Warwickshire ICB	1,413	2,776	50.9
QH8: NHS Mid And South Essex ICB	2,049	4,018	51.0
QF7: NHS South Yorkshire ICB	2,096	4,061	51.6
QNC: NHS Staffordshire & Stoke-On-Tr ICB	1,522	2,936	51.8
QRL: NHS Hampshire And Isle Of Wight ICB	3,499	6,743	51.9
QUA: NHS Black Country ICB	2,002	3,857	51.9
QWE: NHS South West London ICB	1,661	3,202	51.9
QHL: NHS Birmingham And Solihull ICB	1,586	3,008	52.7
QPM: NHS Northamptonshire ICB	1,086	2,017	53.8
QMF: NHS North East London ICB	2,084	3,863	53.9
QRV: NHS North West London ICB	2,481	4,568	54.3
QKK: NHS South East London ICB	2,701	4,754	56.8

Summary

The risk of readmission is higher in those who are:

aged 75-89 years, with those aged under 75 having the lowest risk of readmission
male
Black/Black British
living in the most deprived areas

The risk of readmission varies by ICB area, with a lower risk of readmission in the Gloucestershire and Cornwall and Isles of Scilly ICB areas and a higher risk in the North West London ICB area.

ICB	Readmissions	No. at risk	Percentage
QR1: NHS Gloucestershire ICB	4,148	10,220	40.6
QT6: NHS Cornwall & Isles Of Scilly ICB	3,663	8,823	41.5
QVV: NHS Dorset ICB	8,130	18,927	43.0
QOC: NHS Shrops, Telford & Wrekin ICB	4,462	10,103	44.2
QJM: NHS Lincolnshire ICB	7,376	16,527	44.6
QGH: NHS Herefords & Worcestershire ICB	6,635	14,785	44.9
QMM: NHS Norfolk And Waveney ICB	9,779	21,757	44.9
QOX: NHS Bath & NE S'set, S'don & W ICB	7,496	16,377	45.8
QJK: NHS Devon ICB	11,604	25,029	46.4
QSL: NHS Somerset ICB	6,325	13,593	46.5
QE1: NHS Lancashire & South Cumbria ICB	16,984	36,314	46.8
QJG: NHS Suffolk & North East Essex ICB	9,802	20,893	46.9
QK1: NHS Leics, Leic'shire & Rutland ICB	8,441	18,007	46.9
QNX: NHS Sussex ICB	17,399	37,007	47.0
QKS: NHS Kent And Medway ICB	14,969	31,808	47.1
QOQ: NHS Humber And North Yorkshire ICB	17,588	37,185	47.3
QT1: NHS Nott'ham & Nottinghamshire ICB	10,436	21,526	48.5
QH8: NHS Mid And South Essex ICB	12,217	25,123	48.6
QHG: NHS Beds, Luton & Milton Keynes ICB	7,738	15,858	48.8
QU9: NHS Bucks, Oxford & Berkshire W ICB	14,309	29,297	48.8
QWO: NHS West Yorkshire ICB	20,775	42,578	48.8
QM7: NHS Hertfordshire & West Essex ICB	13,488	27,515	49.0
QOP: NHS Greater Manchester ICB	24,943	50,708	49.2
QYG: NHS Cheshire And Merseyside ICB	28,071	57,082	49.2
QUY: NHS Bristol, N S'set & S Gloucs ICB	8,478	17,189	49.3
QMJ: NHS North Central London ICB	7,702	15,483	49.7
QWE: NHS South West London ICB	10,341	20,598	50.2
QWU: NHS Coventry And Warwickshire ICB	9,928	19,784	50.2
QXU: NHS Surrey Heartlands ICB	11,109	22,127	50.2
QRL: NHS Hampshire And Isle Of Wight ICB	19,659	38,919	50.5
QHM: NHS North East & North Cumbria ICB	37,439	74,048	50.6
QUA: NHS Black Country ICB	13,845	27,287	50.7
QUE: NHS Cambs & Peterborough ICB	8,507	16,773	50.7
QHL: NHS Birmingham And Solihull ICB	12,348	24,058	51.3
QNC: NHS Staffordshire & Stoke-On-Tr ICB	13,845	26,830	51.6
QJ2: NHS Derby And Derbyshire ICB	12,356	23,683	52.2
QF7: NHS South Yorkshire ICB	15,689	29,984	52.3
QMF: NHS North East London ICB	11,399	21,675	52.6
QKK: NHS South East London ICB	13,896	25,951	53.5
QRV: NHS North West London ICB	17,569	32,626	53.8
QPM: NHS Northamptonshire ICB	8,305	15,393	54.0

Multivariate survival analysis of time to readmission (2022/23)

For this analysis we have taken only data from 2022-2023, and only the first admission/time to readmission for each patient.

We have fitted Cox proportional hazard models to our data to assess how various factors independently affect the risk of readmission occurring over time.

For information on the testing of the proportional hazards assumption see Section 1.5.1.

We have used a Cox proportional hazards models and the calculated hazard ratios can be considered as a time-averaged hazard ratio. We have considered models for readmission within 28 days and within 1 yr. There are some differences between the hazard ratios calculated for the two models, but the general trends are consistent.

Elderly emergency

              chisq df      p sig
sex          0.1775  1 0.6736    
age_range    0.0000  1 0.9977    
ethnicity    0.2842  1 0.5939    
imd_decile   0.1389  1 0.7093    
icb         23.0542  1 0.0000   *
GLOBAL     584.1550 59 0.0000   *

              chisq df      p sig
sex        267.1914  1 0.0000   *
age_range    0.1572  1 0.6918    
ethnicity    0.1140  1 0.7356    
imd_decile   2.0735  1 0.1499    
icb          3.1067  1 0.0780    
GLOBAL     998.7890 59 0.0000   *

Summary

In the elderly emergency cohort the risk of readmission:

is higher in males.
is higher in those aged 80-89 years compared to those aged 75-79 years. Up to 28 days the risk of readmission in those aged 90+ is no higher than those aged 75-79 years, but in the full year after admission the risk of readmission is higher in those over 90 years than those aged 75-79 years. This may be influenced by the risk of death being significantly different between those aged 75-79 years and those aged over 90.
is higher in those who are White British, and significantly lower in those who are Asian/Asian British, Black/Black British, Other or Unknown ethnicity. Up to 28 days those of mixed ethnicity have a similar risk of readmission to White British, but in the analysis, but the risk drops below that of White British in the analysis to 1 year.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission is lowest in the Cornwall and Isles of Scilly ICB area. In the year post-admission the risk of readmission is highest in South East London ICB and North West London ICB areas. While up to 28 days post-admission the risk is highest in the North East London ICB area.

Falls

              chisq df      p sig
sex          2.4394  1 0.1183    
age_range  165.7130  1 0.0000   *
ethnicity    0.0638  1 0.8005    
imd_decile   0.2306  1 0.6311    
icb         10.9718  1 0.0009   *
GLOBAL     109.3977 62 0.0002   *

              chisq df      p sig
sex          7.4918  1 0.0062   *
age_range  197.9268  1 0.0000   *
ethnicity    0.0037  1 0.9514    
imd_decile   0.0696  1 0.7919    
icb         18.1754  1 0.0000   *
GLOBAL     113.5035 62 0.0001   *

Summary

In the falls cohort the risk of readmission:

is higher in males.
is higher in those aged over 70 years compared to those aged 60-64 years.
is lower in those of Unknown ethnicity compared to White British. In the analysis to 1 year the risk of readmission is significantly higher in those who are Black/Black British compared to those who are White British.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission in the year post-admission is lowest in the Cornwall and Isles of Scilly ICB and Gloucestershire ICB areas and highest in the South East London ICB and Northamptonshire ICB areas. In the 28 days post-admission the risk of readmission is lowest in the Gloucestershire ICB and Hereford and Worcestershire ICB areas, and highest in the North West London ICB and Staffordshire and Stoke-on-Trent ICB areas.

Frail

              chisq df      p sig
sex          0.8608  1 0.3535    
age_range    1.1072  1 0.2927    
ethnicity    0.3737  1 0.5410    
imd_decile   0.0774  1 0.7809    
icb         97.9359  1 0.0000   *
GLOBAL     503.4398 61 0.0000   *

               chisq df      p sig
sex         158.5313  1 0.0000   *
age_range   421.8780  1 0.0000   *
ethnicity     0.1861  1 0.6662    
imd_decile    3.1498  1 0.0759    
icb           3.9549  1 0.0467   *
GLOBAL     1216.2056 61 0.0000   *

Summary

In the frail cohort the risk of readmission:

is higher in males.
up to 28days age does not significantly influence the risk of readmission.However, in the year post admission the risk of readmission is higher in those aged over 80 years compared to those aged 75-79 years.
is higher in those who are White British, and significantly lower in those who are Asian/Asian British, Other and Unknown ethnicity. Up to 28 days those who are Black/Black British also have a lower risk of readmission compared to White British, but the risk is no longer reduced in the analysis to 1 year.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission in the year post-admission is lowest in the Cornwall and Isles of Scilly ICB and Gloucestershire ICB areas and highest in the South East London ICB and North West London ICB areas. In the 28 days post-admission the risk of readmission is lowest in the Cornwall and Isles of Scilly ICB and Leicester, Leicestershire and Rutland ICB areas, and highest in the Staffordshire and Stoke-on-Trent ICB and North East London ICB areas.

Readmissions- excluding those who died prior to readmission

In the previous analysis of readmissions we see that some of the ICB areas with the lowest readmission rates are those with higher mortality rates. Given that the risk of readmission will be strongly influenced by the mortality rate for this analysis we have excluded all those that died prior to readmission at either 28 days or 1 year. This gives us the risk of readmission for those that survived to the end of the time period of interest, either 28 days or 1 year.

Trends in the percentage of admissions with a subsequent readmission over time

Summary of percentage of patients readmitted within 1 year (2022/23)

All admissions are counted an individual events, so some patients with multiple admissions will be included more than once.

	Elderly Emergency	Frail	Falls
Sex
female	131,242 (18.4%)	80,373 (17%)	11,812 (13%)
male	142,128 (24.3%)	91,533 (21.8%)	9,342 (21.3%)
Age
60-64	N/A	N/A	103 (5.9%)
65-69	N/A	14,819 (13%)	751 (7.4%)
70-74	N/A	23,148 (14.7%)	1,592 (9.4%)
75-79	70,287 (16.5%)	30,350 (16.8%)	2,839 (12%)
80-84	76,907 (19.6%)	36,363 (19.8%)	4,533 (15.5%)
85-89	73,095 (23.9%)	37,646 (23.9%)	5,832 (19.1%)
90+	53,081 (30.1%)	29,580 (29.9%)	5,504 (24.7%)
Ethnicity
Asian/Asian British	6,642 (18.5%)	4,327 (15.9%)	352 (14%)
Black/Black British	3,390 (19.4%)	2,136 (17.9%)	178 (14.5%)
Mixed	636 (19.1%)	470 (18.7%)	47 (15.6%)
Other	2,674 (18.5%)	1,689 (15.5%)	203 (12.8%)
White British	229,032 (21.5%)	143,437 (19.8%)	17,877 (16.2%)
White Other	9,826 (21.1%)	6,071 (19.1%)	772 (15.3%)
Unknown	21,170 (18.6%)	13,776 (16.6%)	1,725 (12.7%)
IMD decile
1	24,858 (23.6%)	16,884 (20.4%)	1,861 (16.8%)
2	25,747 (22.8%)	17,167 (20.5%)	2,129 (17.2%)
3	26,021 (22.3%)	16,923 (20%)	2,149 (17.1%)
4	27,271 (21.7%)	17,171 (19.7%)	2,120 (16.2%)
5	28,248 (21.1%)	17,670 (19.4%)	2,069 (15.1%)
6	28,957 (20.6%)	17,937 (19%)	2,259 (15.5%)
7	29,166 (20.5%)	17,786 (18.9%)	2,186 (15.2%)
8	28,932 (20.1%)	17,690 (18.7%)	2,206 (15.2%)
9	28,235 (19.7%)	17,153 (18.4%)	2,209 (15.3%)
10	25,935 (19.2%)	15,525 (18%)	1,966 (14.4%)

Total	273,370 (21%)	171,906 (19.3%)	21,154 (15.7%)

Comparing time to readmission between the cohorts using Kaplan-meier plots (2022/23)

Survival analysis was conducted where each admission is treated as an independent event. This means some patients who had multiple admissions within 2022/23 will be included multiple times.

Survival analysis was conducted using a patient’s first admission within 2022/23, so only one event is included per patient, even if the patient has multiple admissions over the year.

Kaplan Meier survival plots of time to readmission (2022/23)

For these plots each admission in 2022/23 was treated as an independent event, meaning that some patients who had multiple admissions within 2022/23 will be included multiple times.

Summary

The risk of readmission is higher in those who are:

older
male
Black/Black British
living in a more deprived area

The risk of readmission varies by ICB area, with a lower risk of readmission in the Dorset, Gloucestershire and Cornwall and Isles of Scilly ICB areas.

ICB	Readmissions	No. at risk	Percentage
QR1: NHS Gloucestershire ICB	6,996	12,987	53.9
QT6: NHS Cornwall & Isles Of Scilly ICB	6,202	11,319	54.8
QVV: NHS Dorset ICB	13,822	25,135	55.0
QOC: NHS Shrops, Telford & Wrekin ICB	7,255	12,678	57.2
QOX: NHS Bath & NE S'set, S'don & W ICB	12,216	21,146	57.8
QJM: NHS Lincolnshire ICB	11,260	19,232	58.5
QGH: NHS Herefords & Worcestershire ICB	10,608	18,096	58.6
QMM: NHS Norfolk And Waveney ICB	15,663	26,465	59.2
QJK: NHS Devon ICB	19,908	33,395	59.6
QKS: NHS Kent And Medway ICB	26,739	44,616	59.9
QJG: NHS Suffolk & North East Essex ICB	15,783	26,316	60.0
QNX: NHS Sussex ICB	27,083	45,150	60.0
QSL: NHS Somerset ICB	10,387	17,198	60.4
QK1: NHS Leics, Leic'shire & Rutland ICB	13,641	22,562	60.5
QE1: NHS Lancashire & South Cumbria ICB	26,013	42,872	60.7
QU9: NHS Bucks, Oxford & Berkshire W ICB	22,719	37,137	61.2
QUY: NHS Bristol, N S'set & S Gloucs ICB	13,341	21,693	61.5
QOQ: NHS Humber And North Yorkshire ICB	28,342	45,751	61.9
QRL: NHS Hampshire And Isle Of Wight ICB	31,818	51,063	62.3
QMJ: NHS North Central London ICB	12,054	19,320	62.4
QT1: NHS Nott'ham & Nottinghamshire ICB	15,894	25,387	62.6
QM7: NHS Hertfordshire & West Essex ICB	21,667	34,584	62.7
QH8: NHS Mid And South Essex ICB	18,864	30,044	62.8
QXU: NHS Surrey Heartlands ICB	17,844	28,416	62.8
QWO: NHS West Yorkshire ICB	30,518	48,521	62.9
QYG: NHS Cheshire And Merseyside ICB	40,866	65,001	62.9
QWE: NHS South West London ICB	15,470	24,527	63.1
QWU: NHS Coventry And Warwickshire ICB	15,407	24,241	63.6
QHG: NHS Beds, Luton & Milton Keynes ICB	12,693	19,941	63.7
QOP: NHS Greater Manchester ICB	37,626	58,834	64.0
QNC: NHS Staffordshire & Stoke-On-Tr ICB	21,155	32,748	64.6
QHL: NHS Birmingham And Solihull ICB	19,686	30,408	64.7
QJ2: NHS Derby And Derbyshire ICB	19,204	29,676	64.7
QUE: NHS Cambs & Peterborough ICB	13,284	20,530	64.7
QHM: NHS North East & North Cumbria ICB	58,035	89,588	64.8
QUA: NHS Black Country ICB	21,268	32,826	64.8
QMF: NHS North East London ICB	17,381	26,344	66.0
QKK: NHS South East London ICB	19,899	30,080	66.2
QPM: NHS Northamptonshire ICB	12,257	18,400	66.6
QRV: NHS North West London ICB	27,200	40,801	66.7
QF7: NHS South Yorkshire ICB	25,041	37,453	66.9

Summary

The risk of readmission is higher in those who are:

older
male
Black/Black British
living in a more deprived area

The risk of readmission varies by ICB area.

ICB	Readmissions	No. at risk	Percentage
QT6: NHS Cornwall & Isles Of Scilly ICB	443	1,099	40.3
QR1: NHS Gloucestershire ICB	571	1,326	43.1
QOC: NHS Shrops, Telford & Wrekin ICB	515	1,178	43.7
QGH: NHS Herefords & Worcestershire ICB	925	2,005	46.1
QJK: NHS Devon ICB	1,380	2,927	47.1
QJM: NHS Lincolnshire ICB	913	1,927	47.4
QK1: NHS Leics, Leic'shire & Rutland ICB	1,025	2,119	48.4
QSL: NHS Somerset ICB	856	1,752	48.9
QOX: NHS Bath & NE S'set, S'don & W ICB	1,168	2,379	49.1
QMM: NHS Norfolk And Waveney ICB	1,543	3,114	49.6
QE1: NHS Lancashire & South Cumbria ICB	2,314	4,649	49.8
QVV: NHS Dorset ICB	1,283	2,569	49.9
QOQ: NHS Humber And North Yorkshire ICB	2,056	4,092	50.2
QJG: NHS Suffolk & North East Essex ICB	1,422	2,810	50.6
QJ2: NHS Derby And Derbyshire ICB	1,168	2,295	50.9
QT1: NHS Nott'ham & Nottinghamshire ICB	1,293	2,534	51.0
QNX: NHS Sussex ICB	2,673	5,230	51.1
QU9: NHS Bucks, Oxford & Berkshire W ICB	1,859	3,641	51.1
QMJ: NHS North Central London ICB	1,358	2,557	53.1
QWO: NHS West Yorkshire ICB	2,755	5,161	53.4
QYG: NHS Cheshire And Merseyside ICB	3,412	6,383	53.5
QKS: NHS Kent And Medway ICB	1,794	3,282	54.7
QM7: NHS Hertfordshire & West Essex ICB	2,077	3,785	54.9
QHM: NHS North East & North Cumbria ICB	4,770	8,655	55.1
QOP: NHS Greater Manchester ICB	3,347	6,064	55.2
QXU: NHS Surrey Heartlands ICB	1,553	2,815	55.2
QUY: NHS Bristol, N S'set & S Gloucs ICB	1,331	2,388	55.7
QUE: NHS Cambs & Peterborough ICB	1,242	2,205	56.3
QWU: NHS Coventry And Warwickshire ICB	1,411	2,493	56.6
QWE: NHS South West London ICB	1,660	2,930	56.7
QHG: NHS Beds, Luton & Milton Keynes ICB	1,360	2,396	56.8
QNC: NHS Staffordshire & Stoke-On-Tr ICB	1,522	2,660	57.2
QRL: NHS Hampshire And Isle Of Wight ICB	3,498	6,110	57.3
QH8: NHS Mid And South Essex ICB	2,049	3,546	57.8
QF7: NHS South Yorkshire ICB	2,096	3,610	58.1
QMF: NHS North East London ICB	2,084	3,567	58.4
QUA: NHS Black Country ICB	2,002	3,428	58.4
QHL: NHS Birmingham And Solihull ICB	1,586	2,704	58.7
QRV: NHS North West London ICB	2,481	4,210	58.9
QPM: NHS Northamptonshire ICB	1,086	1,837	59.1
QKK: NHS South East London ICB	2,700	4,392	61.5

Summary

The risk of readmission is higher in those who are:

older
male
Black/Black British
living in the more deprived areas

The risk of readmission varies by ICB area, with a lower risk of readmission in the Dorset, Gloucestershire and Cornwall and Isles of Scilly ICB areas.

ICB	Readmissions	No. at risk	Percentage
QR1: NHS Gloucestershire ICB	4,147	8,414	49.3
QT6: NHS Cornwall & Isles Of Scilly ICB	3,659	7,313	50.0
QVV: NHS Dorset ICB	8,126	16,051	50.6
QOC: NHS Shrops, Telford & Wrekin ICB	4,462	8,496	52.5
QJM: NHS Lincolnshire ICB	7,373	13,712	53.8
QOX: NHS Bath & NE S'set, S'don & W ICB	7,495	13,889	54.0
QGH: NHS Herefords & Worcestershire ICB	6,633	12,127	54.7
QMM: NHS Norfolk And Waveney ICB	9,778	17,794	55.0
QJK: NHS Devon ICB	11,597	20,970	55.3
QSL: NHS Somerset ICB	6,322	11,439	55.3
QK1: NHS Leics, Leic'shire & Rutland ICB	8,440	15,202	55.5
QKS: NHS Kent And Medway ICB	14,963	26,619	56.2
QNX: NHS Sussex ICB	17,392	30,885	56.3
QE1: NHS Lancashire & South Cumbria ICB	16,979	30,071	56.5
QOQ: NHS Humber And North Yorkshire ICB	17,578	30,997	56.7
QJG: NHS Suffolk & North East Essex ICB	9,798	17,236	56.8
QU9: NHS Bucks, Oxford & Berkshire W ICB	14,299	25,103	57.0
QHG: NHS Beds, Luton & Milton Keynes ICB	7,735	13,332	58.0
QUY: NHS Bristol, N S'set & S Gloucs ICB	8,474	14,611	58.0
QH8: NHS Mid And South Essex ICB	12,215	21,027	58.1
QM7: NHS Hertfordshire & West Essex ICB	13,482	23,159	58.2
QT1: NHS Nott'ham & Nottinghamshire ICB	10,433	17,896	58.3
QYG: NHS Cheshire And Merseyside ICB	28,057	48,099	58.3
QMJ: NHS North Central London ICB	7,700	13,192	58.4
QXU: NHS Surrey Heartlands ICB	11,105	19,027	58.4
QWO: NHS West Yorkshire ICB	20,767	35,488	58.5
QOP: NHS Greater Manchester ICB	24,933	42,280	59.0
QRL: NHS Hampshire And Isle Of Wight ICB	19,650	33,313	59.0
QWE: NHS South West London ICB	10,336	17,509	59.0
QHM: NHS North East & North Cumbria ICB	37,420	63,183	59.2
QWU: NHS Coventry And Warwickshire ICB	9,917	16,697	59.4
QNC: NHS Staffordshire & Stoke-On-Tr ICB	13,842	23,180	59.7
QHL: NHS Birmingham And Solihull ICB	12,345	20,644	59.8
QUA: NHS Black Country ICB	13,840	23,137	59.8
QUE: NHS Cambs & Peterborough ICB	8,506	14,005	60.7
QRV: NHS North West London ICB	17,561	28,849	60.9
QJ2: NHS Derby And Derbyshire ICB	12,350	20,187	61.2
QMF: NHS North East London ICB	11,398	18,501	61.6
QF7: NHS South Yorkshire ICB	15,685	25,426	61.7
QKK: NHS South East London ICB	13,890	22,250	62.4
QPM: NHS Northamptonshire ICB	8,304	13,109	63.3

Multivariate survival analysis of time to readmission (2022/23)

For this analysis we have taken only data from 2022-2023, and only the first admission/time to readmission for each patient.

We have fitted Cox proportional hazard models to our data to assess how various factors independently affect the risk of readmission occurring over time.

For information on the testing of the proportional hazards assumption see Section 1.5.1.

Elderly emergency

              chisq df      p sig
sex          0.0056  1 0.9405    
age_range    0.0006  1 0.9808    
ethnicity    0.2727  1 0.6015    
imd_decile   0.3531  1 0.5524    
icb         18.0758  1 0.0000   *
GLOBAL     589.8751 59 0.0000   *

               chisq df      p sig
sex         145.1689  1 0.0000   *
age_range    62.6748  1 0.0000   *
ethnicity     0.4513  1 0.5017    
imd_decile   13.1561  1 0.0003   *
icb           1.9500  1 0.1626    
GLOBAL     1712.1594 59 0.0000   *

Summary

In the elderly emergency cohort the risk of readmission:

is higher in males.
increases with increasing age
is higher in those who are White British, and significantly lower in those who are Asian/Asian British, Black/Black British, Other or Unknown ethnicity. Up to 28 days those of mixed ethnicity have a similar risk of readmission to White British, but in the analysis, but the risk drops below that of White British in the analysis to 1 year.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission is lowest in the Cornwall and Isles of Scilly ICB ares. In the year post-admission the risk of readmission is highest in South East London ICB and Northamptonshire areas. While up to 28 days post-admission the risk is highest in the North East London ICB and South East London ICB areas.

Falls

              chisq df      p sig
sex          2.1144  1 0.1459    
age_range  212.6728  1 0.0000   *
ethnicity    0.0739  1 0.7858    
imd_decile   0.2586  1 0.6111    
icb          9.3915  1 0.0022   *
GLOBAL     108.7835 62 0.0002   *

               chisq df      p sig
sex           0.5675  1 0.4512    
age_range  3917.5227  1 0.0000   *
ethnicity     0.0291  1 0.8646    
imd_decile    0.2145  1 0.6433    
icb           8.1775  1 0.0042   *
GLOBAL      131.4397 62 0.0000   *

Summary

In the falls cohort the risk of readmission:

is higher in males.
is higher in those aged over 70 years compared to those aged 60-64 years.
is lower in those of Unknown ethnicity compared to White British. In the analysis to 1 year post-admission the risk of readmission is also significantly lower in those who are Asian/Asian British or from Other ethnic backgrounds.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission in the year post-admission is lowest in the Cornwall and Isles of Scilly ICB and Gloucestershire ICB areas and highest in the South East London ICB and Northamptonshire ICB areas. In the 28 days post-admission the risk of readmission is lowest in the Leicester, Leicestershire and Rutland ICB and Hereford and Worcestershire ICB areas, and highest in the North West London ICB and Staffordshire and Stoke-on-Trent ICB areas.

Frail

              chisq df      p sig
sex          0.4717  1 0.4922    
age_range    4.4920  1 0.0341   *
ethnicity    0.4003  1 0.5269    
imd_decile   0.2156  1 0.6424    
icb         78.1128  1 0.0000   *
GLOBAL     510.2711 61 0.0000   *

               chisq df      p sig
sex         105.3108  1 0.0000   *
age_range  6502.4524  1 0.0000   *
ethnicity     0.6414  1 0.4232    
imd_decile   13.6494  1 0.0002   *
icb           1.4058  1 0.2358    
GLOBAL     2154.9872 61 0.0000   *

Summary

In the frail cohort the risk of readmission:

is higher in males.
increases with increasing age.
is higher in those who are White British, and significantly lower in those who are Asian/Asian British, Black/Black British, Other and Unknown ethnicity. In the analysis to one year post-admission those who are White Other also have a significantly lower risk of readmission.
increases with increasing deprivation, those living in the most deprived areas (IMD decile 1) are more likely to be readmitted than those living in the least deprived areas (IMD decile 10).
varies by ICB area. The risk of readmission in the year post-admission is lowest in the and Gloucestershire ICB and Cornwall and Isles of Scilly ICB areas and highest in the South East London ICB and Northamptonshire ICB areas. In the 28 days post-admission the risk of readmission is lowest in the Cornwall and Isles of Scilly ICB and Leicester, Leicestershire and Rutland ICB areas, and highest in the Staffordshire and Stoke-on-Trent ICB and North East London ICB areas.

Conclusions

Following an emergency admission the risk of both death, and readmission (in those who do not die within the follow-up period), in all 3 cohorts (elderly emergency, falls or frail) was higher for males, those living in more deprived areas and those who were older at admission.

There was also significant variability in risk of death and readmission between ICB area, even once any differences in the age, ethnicity, sex and deprivation of the areas were accounted for in this analysis.

The risk of death in the year post-admission was lower for those who were Asian/Asian British, Black/Black British or Other ethnicities, compared to White British. There is a general trend towards a higher risk of readmission for those who are White British than those of other ethnicities. In the elderly emergency and frail cohorts the risk of readmission was lower in those who were Asian/Asian British, Black/Black British, Other and Unknown ethnicity. For the falls cohort there are less differences between ethnic groups, but in the 1 year post-admission analysis the risk of readmission is also significantly lower in those who are Asian/Asian British, from Other or Unknown ethnic backgrounds.